| NPI | 1558759522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5814-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1801-226) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2015-11-04 |